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Objective To determine whether initial body mass index for age (zBMI) and internalizing symptoms predict longitudinal changes in zBMI and internalizing symptoms—and the extent to which sex and race moderate these relations. Methods Participants included 12,674 (51% male) youth from the Early Childhood Longitudinal Study, Kindergarten Class 1998–1999. Data were collected in kindergarten, 1st, 3rd, 5th, and 8th grades. Teacher-reported internalizing symptoms were measured with the Social Rating Scale. Results Internalizing symptoms followed a quadratic growth trajectory, with initial low levels of symptoms that gradually increased over time and eventually leveled. zBMI followed a piecewise growth trajectory, with a transition in slope at 1st grade. Interactions emerged between zBMI and internalizing symptoms for White males. Conclusions Associations between internalizing symptoms and BMI begin in early childhood for White males, and changes in zBMI are a function of the interactive effect of initial levels of internalizing difficulties and adiposity status.